Eradication of endotracheal tube biofilm by nebulised gentamicin.

Objective: To compare the efficacy of gentamicin, nebulised via the endotracheal tube (ET), with that of parenteral cefotaxime or parenteral cefuroxime in preventing the formation of ET biofilm.

Setting: General intensive care units in two university teaching hospitals.

Design: The microbiology of ET biofilm from 36 ICU patients eligible to receive antibiotic prophylaxis was examined. Peak and trough tracheal concentrations of gentamicin, cefotaxime or cefuroxime were measured in each patient group, on the 2nd day of intubation.

Patients: Twelve patients received gentamicin (80 mg) nebulised in 4 ml normal saline every 8 h, 12 cefotaxime (1 g, 12 hourly) and 12 cefuroxime (750 mg, 8 hourly). Prophylaxis was continued for the duration of intubation.

Measurements and results: Samples of tracheal secretions were taken on the 2nd day of ventilation for determination of antibiotic concentrations. Following extubation, ETs were examined for the presence of biofilm. Pathogens considered to be common aetiological agents for VAP included Staphylococcus aureus, enterococci, Enterobacteriaceae and pseudomonads. While microbial biofilm was found on all ETs from the cephalosporin group, microbial biofilm of these micro-organisms was found on 7 of the 12 ET tubes from patients receiving cefotaxime [S. aureus (4), pseudomonads (1), Enterobacteriaceae (1), enterococcus (1)] and 8 of the 12 ET tubes from patients receiving cefuroxime [Enterobacteriaceae (6), P. aeruginosa (1) and enterococcus (1)]. While microbial biofilm was observed on five ETs from patients receiving nebulised gentamicin, none of these were from pathogens for ventilator-associated pneumonia (VAP). Tracheal concentrations of both cephalosporins were lower than those needed to inhibit the growth of pathogens recovered from ET tube biofilm. The median (and range) concentrations for cefotaxime were 0.90 (<0.23–1.31) mg/l and 0.28 (<0.23–0.58) mg/l for 2 h post-dose and trough samples, respectively. Two hours post-dose concentrations of cefuroxime (median and range) were 0.40 (0.34–0.83) mg/l, with trough concentrations of 0.35 (<0.22–0.47) mg/l. Tracheal concentrations (median and range) of gentamicin measured 1 h post-nebulisation were 790 (352–>1250) mg/l and then, before the next dose, were 436 (250–1000) mg/l.

Conclusion: Nebulised gentamicin attained high concentrations in the ET lumen and was more effective in preventing the formation of biofilm than either parenterally administered cephalosporin and therefore may be effective in preventing this complication of mechanical ventilation.

Drug and light delivery strategies for photodynamic antimicrobial chemotherapy (PACT) of pulmonary pathogens:a pilot study

Pulmonary disease is the main cause of morbidity and mortality in cystic fibrosis (CF) suffers, with multidrug-resistant Pseudomonas aeruginosa and Burkholderia cepacia complex as problematic pathogens in terms of recurrent and unremitting infections. Novel treatment of pulmonary infection is required to improve the prognosis and quality of life for chronically infected patients. Photodynamic antimicrobial chemotherapy (PACT) is a treatment combining exposure to a light reactive drug, with light of a wavelength specific for activation of the drug, in order to induce cell death of bacteria. Previous studies have demonstrated the susceptibility of CF pathogens to PACT in vitro. However, for the treatment to be of clinical use, light and photosensitizer must be able to be delivered successfully to the target tissue. This preliminary study assessed the potential for delivery of 635 nm light and methylene blue to the lung using an ex vivo and in vitro lung model. Using a fibre-optic light delivery device coupled to a helium-neon laser, up to 11% of the total light dose penetrated through full thickness pulmonary parenchymal tissue, which indicates potential for multiple lobe irradiation in vivo. The mass median aerodynamic diameter (MMAD) of particles generated via methylene blue solution nebulisation was 4.40 µm, which is suitable for targeting the site of infection within the CF lung. The results of this study demonstrate the ability of light and methylene blue to be delivered to the site of infection in the CF lung. PACT remains a viable option for selective killing of CF lung pathogens.

Generation and Characterization of ALX-0171, a Potent Novel Therapeutic Nanobody for the Treatment of Respiratory Syncytial Virus Infection

Respiratory Syncytial Virus (RSV) is an important causative agent of lower respiratory tract infections in infants and elderly. Its fusion (F) protein is critical for virus infection. It is targeted by several investigational antivirals and by palivizumab, a humanised monoclonal antibody used prophylactically in infants considered at high risk of severe RSV disease. ALX-0171 is a trimeric Nanobody that binds the antigenic site II of RSV F-protein with subnanomolar affinity. ALX-0171 demonstrated superior in vitro neutralisation compared to palivizumab against prototypic RSV A and B strains. Moreover, ALX-0171 completely blocked replication below limit of detection in 87% of the viruses tested versus 18% for palivizumab at a fixed concentration. Importantly, ALX-0171 was highly effective in reducing both nasal and lung RSV titers when delivered prophylactically or therapeutically directly to the lungs of cotton rats. ALX-0171 represents a potent novel antiviral compound with significant potential to treat RSV-mediated disease.

Conditionnement de l’endothélium de l’artère pulmonaire par thérapie d’inhalation avant la circulation extracorporelle

La circulation extracorporelle (CEC) déclenche une réaction inflammatoire systémique, un dommage d’ischémie-reperfusion (I-R) et une dysfonction de l’endothélium dans la circulation pulmonaire. L’hypertension pulmonaire (HTP) est la conséquence de cette cascade de réactions. Cette HTP augmente le travail du ventricule droit et peut causer sa dysfonction, un sevrage difficile de la CEC et une augmentation des besoins de vasopresseurs après la chirurgie cardiaque. L’administration de milrinone et d’époprosténol inhalés a démontré une réduction de la dysfonction endothéliale dans l’artère pulmonaire. Le but de ce travail est d’évaluer différents types de nébulisateur pour l’administration de la milrinone et d’évaluer l’effet du traitement préventif de la combinaison de milrinone et époprosténol inhalés sur les résultats postopératoires en chirurgie cardiaque. Deux études ont été conduites. Dans la première, trois groupes de porcelets ont été comparés : (1) groupe milrinone avec nébulisateur ultrasonique ; CEC et reperfusion précédées par 2,5 mg de milrinone inhalée, (2) goupe milrinone avec nébulisateur à simple jet ; CEC et reperfusion précédées par 2,5 mg de milrinone inhalée et (3) groupe contrôle ; CEC et reperfusion sans traitement. Durant la procédure, les paramètres hémodynamiques, biochimiques et hématologiques ont été mesurés. Après sacrifice, la relaxation endothélium dépendante de l’artère pulmonaire à l’acétylcholine et à la bradykinine a été étudiée en chambres d’organe. Nous avons noté une amélioration de la relaxation de l’endothélium à la bradykinine et à l’acétylcholine dans le groupe avec inhalation de milrinone avec le nébulisateur ultrasonique. Dans la deuxième étude, une analyse rétrospective de 60 patients à haut risque chirurgical atteints d’HTP et opérés à l’Institut de Cardiologie de Montréal à été effectuée. Deux groupes ont été comparés : (1) 40 patients ayant reçu la combinaison de milrinone et d’époprosténol inhalés avant la CEC (groupe traitement) et (2) 20 patients avec des caractéristiques préopératoires n’ayant reçu aucun traitement inhalé avant la CEC (groupe contrôle). Nous avons observé que les besoins en support pharmacologique vasoactif était réduit à 12 heures et à 24 heures postopératoires dans le groupe traitement. L’utilisation de la nébulisation ultrasonique a un impact favorable sur l’endothélium de l’artère pulmonaire après la CEC lorsque comparée à la nébulisation standard à simple jet. Le traitement préventif des patients atteints d’HTP avec la combinaison de milrinone et d’époprosténol inhalés avant la CEC est associé avec une diminution importante des besoins de support vasoactif aux soins intensifs dans les 24 premières heures après la chirurgie.

Hydrolysis of N2O5 on sub-micron mineral salt aerosols

The kinetics of reactive uptake of gaseous N2O5 on sub-micron aerosol particles composed of aqueous ammonium sulfate, ammonium hydrogensulfate and sodium nitrate has been investigated. Uptake was measured in a laminar flow reactor, coupled with a differential mobility analyser (DMA) to obtain the aerosol size distribution, with N2O5 detection using NO chemiluminescence. FTIR spectroscopy was used to obtain information about the composition and water content of the aerosol particles under the conditions used in the kinetic measurements. The aerosols were generated by the nebulisation of aqueous salt solutions. The uptake coefficient on the sulfate salts was in the range [gamma]=0.0015 to 0.033 depending on temperature, humidity and phase of the aerosol. On sodium nitrate aerosols the values were much lower, [gamma]<0.001, confirming the inhibition of N2O5 hydrolysis by nitrate ions. At high humidity (>50% r.h.) the uptake coefficient on liquid sulfate aerosols is independent of water content, but at lower humidity, especially below the efflorescence point, the reactivity of the aerosol declines, correlating with the lower water content. The lower uptake rate on solid aerosols may be due to limitations imposed by the liquid volume in the particles. Uptake on sulfate aerosols showed a negative temperature dependence at T>290 K but no significant temperature dependence at lower temperatures. The results are generally consistent with previous models of N2O5 hydrolysis where the reactive intermediate is NO2+ produced by autoionisation of nitrogen pentoxide in the condensed phase.

Entwicklung einer Online-Kopplung der Gelelektrophorese mit der induktiv gekoppelten Plasma-Massenspektrometrie und deren Anwendung in der Bioanalytik

Die Elementmassenspektrometrie wurde in den letzten Jahren sehr erfolgreich zur Aufklärung verschiedener Fragestellungen in der Bioanalytik eingesetzt. Hierbei spielen vor allem Kopplungstechniken von Trennmethoden wie der Flüssigchromatographie (LC) oder der Kapillarelektrophorese (CE) mit der induktiv gekoppelten Plasma-Massenspektrometrie (ICP-MS) als Multielementdetektor mit hervorragenden Quantifizierungseigenschaften eine entscheidende Rolle bei der Untersuchung von Biopolymeren und deren Wechselwirkung mit verschiedenen Metallen. So wurden beispielsweise verschiedene Methoden für die Trennung und Detektion von Metalloproteinen oder DNA-Metall-Addukten in unterschiedlichen Probenmaterialien entwickelt. Die traditionelle und leistungsstärkste Trennmethode für Biopolymere aller Art, die Gelelektrophorese, wurde jedoch bislang nicht in einem Online-Verfahren an die ICP-MS gekoppelt, um solche Fragestellungen zu bearbeiten. Verschiedene Versuche auf der Basis der Laserablation wurden in diese Richtung unternommen, wobei diese Techniken als sehr umständlich und zeitaufwändig anzusehen sind. In dieser Arbeit wird erstmals die technische Realisierung einer Online-Kopplung der Gelelektrophorese mit der ICP-MS beschrieben. Das System basiert auf einem Prinzip aus der präparativen Gelelektrophorese, in welcher eine kontinuierliche Elution der getrennten Komponenten aus dem Gel während der laufenden Elektrophorese durchgeführt wird. Die eluierten Komponenten werden mit dem Elutionspuffer direkt in das Zerstäubersystem des ICP-MS geführt. Die ersten Untersuchungen wurden am Beispiel der Fragemente von doppelsträngiger DNA (dsDNA) durchgeführt. Kommerziell erhältliche Standardlösungen wurden mit der Online-GE-ICP-MS mittels Detektion von 31P an einem hochauflösenden Massenspektrometer mit einer Massenauflösung von 4000 analysiert. Die Trennbedingungen (z.B. pH-Wert oder Ionenstärke der Pufferlösungen) wurden für die Trennung von dsDNA-Fragementen in Agarosegelen optimiert und auf verschiedene dsDNA-Fragmente angewandt. In einem nächsten Schritt wurden die Quantifizierungsmöglichkeiten für Biopolymere untersucht. Sehr kleine Mengen an dsDNA konnten mit einer Präzision von weniger als 3% quantifiziert werden. Hierfür kamen verschiedene Möglichkeiten der externen Kalibration zum Einsatz, wie der Kalibration mit einem Phosphat-Standard oder einem kommerziell erhältlichen quantitativen dsDNA-Standard. Um das Potenzial der entwickelten Methode für die Untersuchung von Biopolymer-Metall-Wechselwirkungen zu demonstrieren, wurden Oligonukleotide mit Cisplatin unter physiologischen Bedingungen inkubiert und die Reaktionsprodukte mit der Online-GE-ICP-MS mittels 31P- und 195Pt-Detektion untersucht. Verschiedene Cisplatin-Oligonukleotid-Addukte konnten auf diese Weise beobachtet werden, was zur Identifizierung die Anwendung der MALDI-TOF-MS als komplementärer Form der Massenspektrometrie notwendig machte. Abschließend wurde die Isotopenverdünnungsanalyse zum Zweck der Quantifizierung herangezogen.

Optimierung der Inhalationstherapie bei Kindern und Mukoviszidose-Patienten

Die pulmonale Applikation von Arzneimitteln hat in den vergangenen Jahren zu- rnnehmend an Bedeutung gewonnen und wird vor allem in der lokalen Therapie bei Asthma, COPD und Mukoviszidose genutzt. Als neues innovatives Inhalationsgerät befindet sich der Respimat® seit 2004 auf dem Arzneimittelmarkt und ist bisher nur für Erwachsene zugelassen. Daher wurden im Rahmen dieser Arbeit die Anwendbarkeit und die Modifikation des Respimats® bei Kindern untersucht. Zusammenfassend zeigen die Ergebnisse, dass Kinder ab einem Alter von fünf Jahren fähig sind suffizient mit dem Respimat® zu inhalieren und gute Werte für die estimierte Intrathorakaldosis zu erreichen. Besonders Kinder von 9-12 Jahren und Patienten mit DPI- oder Autohaler®-Inhalationserfahrung erreichten aufgrund eines hohen Atemflusses eine niedrigere estimierte Intrathorakaldosis als es das Potenzial des Respimats® erlaubt hätte. Durch den Einbau eines höheren internen Widerstands in den Orginalrespimat® wurde der Atemfluss signifikant verlangsamt und die Intrathorakaldosis erhöht. Des Weiteren wurden in der vorliegenden Arbeit die physikalisch-chemische Kompatibilität und die aerodynamischen Eigenschaften von Mischinhalationslösung/-suspensionen untersucht. In der Praxis mischen Muko-viszidose-Patienten oftmals mehrere Fertigarzneimittel und inhalieren diese simultan. Dadurch wird der Zeitaufwand der täglichen Inhalation reduziert und die Compliance sowie die Lebensqualität verbessert. Die 4er Kombination aus Colistimethat mit konservierungsmittelfreier Salbutamolsulfat, Ipratropiumbromidinhalationslösungen und Fluticason-17-propionatinhalationssuspension erwies sich als physikalisch-chemisch kompatibel. Die entwickelte mikrobiologische Wertbestimmungsmethode erwies sich als robust, präzise, gut reproduzierbar und erfüllte alle Anforderungen des statistischen Modells. Weiterhin wurden die aerodynamischen Eigenschaften einer praxisrelevanten 3er Mischinhalationssuspension aus Salbutamolsulfat, Ipratropiumbromid und Fluticason-17-propionat im Vergleich zu deren konsekutiven Vernebelung mittels Kaskadenimpaktion betrachtet. Die Charakteristik des erzeugten Aerosols änderte sich für simultan vernebeltes Salbutamolsulfat und Ipratropiumbromid nicht, wohingegen Fluticason-17-propionat bei simultaner Vernebelung eine Reduktion des MMADs, der delivered dose und der recovery aufwies. Dennoch ist die inhalative Glukokortikoiddosis ausreichend hoch um eine effektive antiinflammatorische Wirkung zu gewährleisten. Daher kann die simultane Inhalation der 3er Kombination empfohlen werden und somit die Compliance und die Lebensqualität von Mukoviszidosepatienten erhöht werden.rn

Evaluation of respiratory function by barometric whole-body plethysmography in healthy dogs.

The objective of the present study was to assess the validity of barometric whole-body plethysmography (BWBP), to establish reference values, and to standardise a bronchoprovocative test to investigate airway responsiveness using BWBP in healthy dogs. BWBP measurements were obtained from six healthy beagle dogs using different protocols: (1) during three consecutive periods (3.5min each) in two morning and two evening sessions; (2) before and after administration of two protocols of sedation; (3) before and after nebulisation of saline and increasing concentrations of carbachol and histamine both in conscious dogs and in dogs under both protocols of sedation. Enhanced pause (PENH) was used as index of bronchoconstriction. Basal BWBP measurements were also obtained in 22 healthy dogs of different breeds, age and weight. No significant influence of either time spent in the chamber or daytime was found for most respiratory variables but a significant dog effect was detected for most variables. A significant body weight effect was found on tidal volume and peak flow values (P<0.05). Response to carbachol was not reproducible and always associated with side effects. Nebulisation of histamine induced a significant increase in respiratory rate, peak expiratory flow, peak expiratory flow/peak inspiratory flow ratio and PENH (P<0.05). The response was reproduced in each dog at different concentrations of histamine. Sedation with acepromazine+buprenorphine had little influence on basal measurements and did not change the results of histamine challenge. It was concluded that BWBP is a safe, non invasive and reliable technique of investigation of lung function in dogs which provides new opportunities to characterise respiratory status, to evaluate airway hyperresponsiveness and to assess therapeutic interventions.

Poly (D,L-Lactide) based microspheres for pulmonary delivery of proteins

Initial work focused on the preparation, optimisation and characterisation of poly (D,L-lactide) (PLA) microspheres with the aim of optimising their formulation based on minimizing the particle size into the range suitable for pulmonary delivery to alveoli. In order to produce dry powders and to enhance their long-term physico-chemical stability, microspheres were prepared as a dry powder via freeze-drying. Optimisation studies showed that using appropriate concentrations of polymer 3% (w/v) in organic phase and emulsifier 10% (w/v) in external aqueous phase, the double solvent evaporation method produced high protein loading microspheres (72 ± 0.5%) with an appropriate particle size for pulmonary drug delivery. Combined use of trehalose and leucine as cyroprotectants (6% and 1% respectively, w/v) produced freeze-dried powders with the best aerosolisation profile among those tested. Although the freeze-dried PLA microsphere powders were not particularly respirable in dry powder inhalation, nebulisation of the rehydrated powders using an ultrasonic nebuliser resulted in improved aerosilisation performance compared to the air-jet nebuliser. When tested in vitro using a macrophage cell line, the PLA microspheres system exhibited a low cytotoxicity and the microspheres induced phagocytic activity in macrophages. However, interestingly, the addition of an immunomodulator to the microsphere formulations (4%, w/w of polymer) reduced this phagocytic activity and macrophage activation compared to microspheres formulated using PLA alone. This suggested that the addition of trehalose dibehenate may not enhance the ability of these microspheres to be used as vaccine delivery systems.

High-sensitivity differential scanning calorimetry for measurement of steroid entrapment in nebulised liposomes generated from proliposomes

A novel approach to the determination of steroid entrapment in the bilayers of aerosolised liposomes has been introduced using high-sensitivity differential scanning calorimetry (DSC). Proliposomes were dispersed in water within an air-jet nebuliser and the energy produced during atomisation was used to hydrate the proliposomes and generate liposome aerosols. Proliposomes that included the steroid beclometasone dipropionate (BDP) produced lower aerosol and lipid outputs than steroid-free proliposomes. Size analysis and transmission electron microscopy showed an evidence of liposome formation within the nebuliser, which was followed by deaggregation and size reduction of multilamellar liposomes on nebulisation to a two-stage impinger. For each formulation, no difference in thermal transitions was observed between delivered liposomes and those remaining in the nebuliser. However, steroid (5 mole%) lowered the onset temperature and the enthalpy of the pretransition, and produced a similar onset temperature and larger enthalpy of the main transition, with broadened pretransition and main transitions. This indicates that BDP was entrapped and exhibited an interaction with the liposome phospholipid membranes. Since the pretransition was depressed but not completely removed and no phase separation occurred, it is suggested that the bilayers of the multilamellar liposomes can entrap more than 5 mole% BDP. Overall, liposomes were generated from proliposomes and DSC investigations indicated that the steroid was entrapped in the bilayers of aerosolised multilamellar vesicles.

IMPROVED SAMPLE INTRODUCTION SYSTEMS FOR INDUCTIVELY COUPLED PLASMA OPTICAL EMISSION SPECTROMETRY AND THEIR APPLICATION TO THE ANALYSIS OF SIMPLE AND COMPLEX MATRICES

The objective of this thesis is to explore new and improved methods for greater sample introduction efficiency and enhanced analytical performance with inductively coupled plasma optical emission spectrometry (ICP-OES). Three projects are discussed in which the capabilities and applications of ICP-OES are expanded: 1. In the first project, a conventional ultrasonic nebuliser was modified to replace the heater/condenser with an infrared heated pre-evaporation tube. In continuation from previous works with pre-evaporation, the current work investigated the effects of heating with infrared block and rope heaters on two different ICP-OES instruments. Comparisons were made between several methods and setups in which temperatures were varied. By monitoring changes to sensitivity, detection limit, precision, and robustness, and analyzing two certified reference materials, a method with improved sample introduction efficiency and comparable analytical performance to a previous method was established. 2. The second project involved improvements to a previous work in which a multimode sample introduction system (MSIS) was modified by inserting a pre-evaporation tube between the MSIS and torch. The new work focused on applying an infrared heated ceramic rope for pre-evaporation. This research was conducted in all three MSIS modes (nebulisation mode, hydride generation mode, and dual mode) and on two different ICP-OES instruments, and comparisons were made between conventional setups in terms of sensitivity, detection limit, precision, and robustness. By tracking both hydride-forming and non-hydride forming elements, the effects of heating in combination with hydride generation were probed. Finally, optimal methods were validated by analysis of two certified reference materials. 3. A final project was completed in collaboration with ZincNyx Energy Solutions. This project sought to develop a method for the overall analysis of a 12 M KOH zincate fuel, which is used in green energy backup systems. By employing various techniques including flow injection analysis and standard additions, a final procedure was formulated for the verification of K concentration, as well as the measurement of additives (Al, Fe, Mg, In, Si), corrosion products (such C from CO₃²¯), and Zn particles both in and filtered from solution. Furthermore, the effects of exposing the potassium zincate electrolyte fuel to air were assessed.